Problems with saliva Flashcards
4 functions of saliva in the oral cavity?
- Acid buffering
- Mucosal lubrication- speech, swallowing
- Taste facilitation
- Antibacterial
5 causes of dry mouth?
- Salivary gland disease
- Drugs
- Medical conditions and dehydration
- Radiotherapy and cancer treatments
- Anxiety and somatisation disorders
Which gland is associated with acinar tissue loss ?
- Minor glands
Which other glands are associated with acinar tissue loss by age other than minor glands?
- Parotid and submandibular
What do we call drugs that cause dry mouth?
Anti-muscarinic cholinergic drugs
An example of an antimuscarinic drug?
Amitriptyline
3 other drugs that cause dry mouth apart from amitriptyline?
- Lithium
- SSRI , TCA
- Bendrofluazide (10% reduction)
5 chronic medical conditions that induce dehydration?
- Diabetes
- Renal disease
- Stroke
- Addison’s
- Persisting vomiting
4 acute medical problems cause dehydration?
- Acute oral mucosal diseases
- Burns
- Vesiculobullous diseases
- Haemorrhage
What 5 diseases causes direct salivary problems?
- ectodermal dysplasia
- Sarcoidosis
- HIV disease
- Gland infiltration amyloid and haemachromatosis
- Cystic fibrosis
What is Challacombe scale for oral dryness?
A scale to measure oral dryness into mild, moderate and severe determined by 10 components which can be assessed visually
1-3 mild
3-6 moderate
7-10 severe
Chalacombe 1?
mirror sticks to buccal mucosa
Chalacombe 2?
mirror sticks to tongue
Chalacombe 3?
Frothy saliva
Chalacombe 4?
no saliva pooling in floor of mouth
Chalacombe 5?
mild depapillation on tongue
Chalacombe 6?
Altered gingival architecture
Chalacombe 7 ?
Glassy appearance mucosa - esp palate
Chalacombe 8?
Fissured tongue
Chalacombe 9 ?
Cervical caries
Chalacombe 10?
Debris on palate or teeth
5 blood tests to investigate salivary disease?
- FBC
- U&E
- LFT
- Glucose
- Anti - ro,la, ANA
- C3 and C4 complement
4 imaging modalities to investigate salivary disease?
- Plain radiographs with reduced dose to look for stones
- Sialography with contrast to show ducts
- MR Sialography - IV contrast
- Ultrasound
Which protein blood test would you carry out to investigate a salivary disease?
C-reactive protein
What two ways can anxiety contribute to the feeling of dry mouth?
- cephalic control of salivation - directly causes xerostomia
- cephalic control of perception - small changes at synapses causing perception of dry mouth
Give 5 examples of somatoform diseases?
- Oral dysaesthesia
- TMD pain
- Headache
- Dyspesia
- Irritable bowel syndrome
What are somatoform diseases?
the development of symptoms although there is no presence of the disease process on examination, mostly caused by the patient perception
What two things on an ultrasound would indicate a salivary issue?
- Leopard spots
- Sialectasis
2 blood tests to investigate dehydration?
U&E
Glucose
2 blood tests to investigate autoimmune disease causing hyposalivation? other than anti la , ro
ANA
CRP
When would you decide to do a sialography for a patient with hyposalivation?
when you suspect obstruction or ductal disease
3 causes that cause increased salivary flow?
Dementia
Stroke
Drug causes
2 causes that lead to perception of hypersalivation?
- swallowing failure - anxiety, stroke, MS
- postural drooling - in babies , cerebral palsy
3 drugs that may cause hypersalivation?
- Clozapine
- Bromides
- Ketamine
3 management options for dealing with hypersalivation?
- Treat the cause - anxiety
- Training on swallowing control
- Surgery - gland removal or duct repositioning
- Anti-muscarinic drugs
